Each year over 1 million Americans 65 years of age or older suffer from acute coronary ischemic syndromes (ACS), and this figure is expected to double over the next 30 years. However, despite recent advances in therapy, the prognosis following an acute coronary event declines progressively with advancing age. Moreover, although prior studies have provided important insights into the pathogenesis of ACS in older patients, the fundamental mechanisms underlying the poor acute-phase and long term prognosis of these patients have not been elucidated. Accordingly, the SPECIFIC AIMS of the Second Pivotal Research in Cardiovascular Syndromes in the Elderly (PRICE-2) conference are: 1. to assemble a cadre of leading basic science and clinical investigators for a l-day forum designed to intensively review current knowledge regarding ACS in older patients, to identify critical gaps in existing knowledge, and to formulate a research agenda highlighting particularly promising avenues for future scientific investigation; 2. to stimulate open discussion and foster collaborative investigation between gerontologists, geriatricians, cardiologists, epidemiologists, and clinical and basic scientists interested in understanding the complex interactions between aging and atherosclerotic cardiovascular disease; 3. to attract young investigators who are potentially interested in cardiovascular aging research; and 4. to disseminate the findings and conclusions of the conference through publication of the proceedings in suitable electronic and print formats. To achieve these objectives, PRICE-2 will be convened in Anaheim, CA on November 10, 2001, immediately preceding the Annual Scientific Sessions of the American Heart Association. This full-day conference will feature distinguished basic science and clinical investigators, and will explore existing knowledge concerning the interactions between age, atherosclerosis, and acute coronary events. Critical gaps in knowledge that require additional research will be defined, and PRICE-2 will also serve as a forum for an active interchange of ideas between basic and clinical investigators in diverse fields, ranging from epidemiology and geriatrics to molecular biology and genetics. Further, PRICE-2 will engage women and minority group clinicians and researchers, and will foster the development of young investigators interested in cardiovascular aging research. Significance. ACS in the elderly are a major public health problem in 2001, and will become increasingly more so as the population ages. PRICE-2 will serve to advance research in this field by defining a near-term research agenda, fostering research collaborations, and stimulating young investigators to pursue careers in cardiovascular aging research.